Childhood Obesity: It Takes a Village to Raise A Child — and To Lower His Weight
A patient came into the clinic recently—or perhaps “patients” would be more accurate—to get some assistance with a growing weight problem.
The primary patient was a pre-teen girl, but of course, her parents came along, and that’s good, because no child can actually tackle a weight problem unless her parents are really on board, both in spirit and in practice.
On the other hand, it’s not any easier for the child to have the whole crew on board it ends up just rocking the boat.
Virtually all the psychosocial issues of obesity that adults must contend with have to be confronted by children with weight problems, too. And you can add to those the fact that even in the best of circumstances, even the most responsible and earnest among these little people can’t entirely control their diet and activity. And the younger the child, the truer that is. They have to rely on the adults in their world to make appropriate choices for them, then to teach them to make their own appropriate choices, then to rigorously reinforce and support them—not for a couple weeks or months, but for their entire youth.
But it gets even trickier: they have to be able to rely on that kind of support not just from mom or dad, but from mom AND dad, and from older siblings, grandparents, teachers, babysitters and any other adults in positions of influence.
That’s what makes treating children with weight problems so much more complicated than treating independent adults. A solid, comprehensive approach to a child’s weight problem usually requires some level of participation from the whole family—or two! The girl I saw recently was lucky—she had both of her parents in the home, and both of them agreed on a course of treatment.
That isn’t always the case. When parents are divorced, even if there is no tension or bad will between the parties, an approach that works for one side of the dissolved family may not work for the other, it’s harder to find common ground than when everyone is under one roof. And that’s when people are generally cooperative and amicable.
If there is an acrimonious relationship, we know that children are too often caught in the cross-fire. Some parents will undermine each other’s efforts to help the child lose weight, simply to be contrary, sometimes asserting that the weight loss is unnecessary, sometimes disputing the details. Extended family might be supportive in keeping a child on track and help smooth matters for that caught-in-the-middle youngster, but not if they end up taking sides and joining in the battle.
Even low levels of that sort of conflict can make the weight-loss challenge an insurmountable task, as these children—and even their parents—turn to emotional eating to help them cope with the tension. But even when parents are still together and harmony abounds, dieting can be a source of friction. Parents often have genuine differences of opinion about what is best for a child, and when one parent is more easy-going and indulgent, leaving the other to play the heavy, it’s usually the child who ends up even heavier.
It doesn’t seem like it should be that difficult. People instinctively tend to protect children and look out for them. We keep them out of traffic, and put hazards out of their reach; we bundle them up when it’s cold, and slather them with sunscreen when it’s hot. Not even a total stranger would stand idly by and watch a child drink poison or run off to play with the gators.
But even though most of us know one or two children who are slowly but surely inching their way toward disease and disability already, intervention is a lot more complicated than snatching the child out of harms way. A good place to start is with a medical assessment to see if the child is at any medical risk because of the extra weight he’s carrying around or if he’s already experiencing problems.
A lifestyle assessment examining dietary and activity habits can help put the truth of a child’s –and the whole family’s—habits down in black and white where it’s easier to identify the problems and overcome any denial that might be at play about its seriousness.
It’s also helpful for parents and other adults around a heavy child to understand the consequences of childhood obesity. Type !! diabetes is skyrocketing among children, as with the rest of the population. The incidence of orthopedic surgeries for heavy children with musculoskeletal problems is rising right along with kids’ average weights. And that “baby fat” story is really losing its credibility by age 5 or 6. The longer a child is overweight, the greater the likelihood that he’ll stay that way throughout his life. And a recent study showed that in terms of overall quality of life,–physically, socially, emotionally and mentally—obese children don’t do any better than those afflicted with terminal cancer. It’s not a happy outlook for a chubby child.
But once they get a good clear look at where they are compared to a healthy body and a healthy lifestyle, overweight children and their families almost always want to do the best thing for the child, and even when there is a lot of disagreement (for whatever reason) on how to go about it, people can almost always find some common ground to start from, even if it’s just cutting back on seconds and snacks.
Obesity has become a bigger and bigger medical problem for people of all ages. If the complex nature of obesity and weight problems were limited to the strictly physical, that would be challenge enough. But the irksome truth is that obesity is simply loaded with ancillary complications, about self-esteem and social adjustment and personal interaction and emotional coping skills, and it’s even harder for kids who can’t control their own environments, or often, their appropriately childish desires.
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